Health Care Proxy Information and Form Use this information and form to help you choose someone to make medical decisions for you in case you are unable to do so for yourself. Medicare Wellness Survey Please complete this survey before your annual medicare wellness assessment visit. HIPAA Notice of Privacy Practices HIPAA Notice of Privacy Practices DNR Order State of New York Do Not Resuscitate form Release Medical Records Out of Office Please use this form to transfer your medical records out of this office. Department of Transportation Physical Form Please fill out as much information as you can and bring the form to your physical appointment. Release Medical Records Into Office 2019 Please use this form to transfer your medical records into this office from another doctor’s office.